- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,543.03 / $3,955.04
| Facility | | $1,518.41 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.18 / $112.63 / $203.06
| Professional | | $77.18 | $112.63 | $203.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.65 / $191.33 / $214.07
| Professional | | $113.65 | $191.33 | $214.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.65 / $171.00 / $362.13
| Professional | | $78.65 | $171.00 | $362.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,052.00 / $5,510.00
| Facility | | $1,812.00 | $4,052.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.43 / $188.94 / $319.51
| Professional | | $129.43 | $188.94 | $319.51 |